Treatment for childhood cancer - long-term risks

Today's cancer treatments help cure most children with cancer. These treatments also may cause health problems later on. These are called late effects.

Late effects are treatment side effects that appear several months or years after treatment for cancer. Late effects can impact one or more areas of the body. Effects can be mild to severe.

Whether your child will have late effects depends on the type of cancer and the treatments your child has. Being aware of your child's risk of long-term health problems can help you follow up with health care providers and detect any problems early.

What Causes Late Effects

Some cancer treatments damage healthy cells. Part of the damage is not seen during treatment, but as the child's body grows, changes in cell growth or function appear.

The medicines used for chemotherapy and the high-energy rays used in radiation therapy can harm healthy cells. This damage can change or delay the way cells grow. Radiation therapy has a more direct effect on long-term growth than chemotherapy.

Your child's health care team will come up with a treatment plan to avoid harming healthy cells as much as possible.

Risk Factors

Every child is unique. The risk of getting a late effect depends on many factors such as:

• Child's overall health before cancer
• Child's age at the time of treatment
• Dose of radiation therapy and what body organs received radiation
• Chemotherapy type and total dose
• How long the treatment was given
• Type of cancer being treated and the area of body involved
• Child's genetic background (some children are more sensitive to treatments)

Types of Late Effects

There are many types of late effects that may occur depending on where the cancer was and what types of treatments were done. Late effects are generally predictable based on a child's specific treatments. Many of the effects can be managed. The following are examples of some late effects based on body parts affected. Note that this is a complete list and not all effects will apply to a child depending on the specific treatments.

Brain:

• Learning
• Memory
• Attention
• Language
• Behavior and emotional problems
• Seizures, headaches

  Seizures

  A seizure is the physical changes in behavior that occurs during an episode of specific types of abnormal electrical activity in the brain. The term ...

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  Headaches

  A headache is pain or discomfort in the head, scalp, or neck. Serious causes of headaches are rare. Most people with headaches can feel much better...

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Ears:

• Hearing loss
• Ringing in the ears

  Ringing in the ears

  Tinnitus is the medical term for "hearing" noises in your ears. It occurs when there is no outside source of the sounds. Tinnitus is often called "r...

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• Dizziness

  Dizziness

  Dizziness is a term that is often used to describe 2 different symptoms: lightheadedness and vertigo. Lightheadedness is a feeling that you might fai...

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Eyes:

• Vision problems
• Dry or watery eyes
• Sensitivity to light

  Sensitivity to light

  Photophobia is eye discomfort in bright light.

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• Irritation
• Drooping eyelid

  Drooping eyelid

  Eyelid drooping is excess sagging of the upper eyelid. The edge of the upper eyelid may be lower than it should be (ptosis) or there may be excess b...

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• Eyelid tumors

Lungs:

• Infections
• Shortness of breath
• Persistent cough
• Trouble breathing

Mouth:

• Small or missing teeth
• Risk for cavities
• Sensitive teeth
• Delayed tooth development
• Gum disease

  Gum disease

  Gingivitis is inflammation of the gums.

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• Dry mouth

  Dry mouth

  Dry mouth occurs when you don't make enough saliva. This causes your mouth to feel dry and uncomfortable. Dry mouth that is ongoing may be a sign o...

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Other late effects may include:

• Muscle or bone can be affected in any area of the body where treatments were needed. It may impact how a child walks or runs or cause bone or muscle pain, weakness, or stiffness.
• Glands and organs that make hormones may be exposed to treatments. These include the thyroid gland in the neck and pituitary gland in the brain. This can have an effect on later growth, metabolism, puberty, fertility, and other functions.
• The heart's rhythm or function may be affected by certain treatments.
• A small increase in risk of getting another cancer later in life.

Most of the effects above are physical. There may be long-term emotional effects as well. Coping with health problems, extra medical visits, or the worries that come with cancer can be a lifelong challenge.

Preventing Health Problems

Many late effects cannot be prevented, but others can be managed or treated.

There are some things your child can do to help prevent other health problems and detect problems early such as:

• Eating healthy foods
• Not smoking or using tobacco
• Exercising regularly
• Maintaining a healthy weight
• Seeing their provider regularly to have regular screenings and tests, including the heart and lungs

Follow-Up

Watching for late effects will be a key part of your child's care for many years. The Children's Oncology Group (COG) creates guidelines for long-term follow-up in children and adolescents who have had cancer. Ask your child's provider about the guidelines. Follow these general steps:

• Make regular appointments for physical exams and tests.
• Keep detailed records of your child's treatments.
• Get copies of all medical reports.
• Keep a contact list of your child's health care team.
• Follow up with an oncologist or member of the survivorship or late-effects team.
• Ask your child's provider what late effects your child may want to look out for based on the treatments.
• Share information about the cancer with future providers.

Regular follow-up and care give your child the best chance of recovery and good health.